Massage Professionals Article Archive

by Nicole Cutler, L.Ac.

Approximately 17 million people in the United States currently have diabetes, and the number is growing. Odds are that most massage therapists either have a diabetic client, or will treat one soon. Diabetes is a complex disease, occurring when the body is unable to maintain the proper levels of blood sugar, or glucose, due to an inability to produce or properly use insulin. Studies have demonstrated the place bodywork has in diabetes maintenance, and an increasing number of sufferers are recognizing the value various alternative therapies can have on their health.

Below are three reasons massage therapy is beneficial to diabetics:

1. Relaxation - Duke Medical University researchers have confirmed that stress management can lower blood glucose levels. A Touch Research Institute study demonstrated that massage therapy lowers blood glucose levels in children with Diabetes Mellitus. A study at New Mexico University showed that a short stress-relief program including touch could lower blood sugar and improve health in diabetic patients.

When the body encounters stress, it prepares itself for a "fight or flight" reaction by raising blood glucose levels. Since raised blood glucose levels are detrimental to diabetics, methods of reducing stress, such as massage therapy, can have a profound effect on preventing blood sugar surges.

2. Circulation - There is no getting around the fact that massage can increase circulation, thereby encouraging the efficient transport of oxygen and nutrients throughout the body. Improved circulation, in turn, improves the cells' insulin uptake.

3. Tissue Flexibility - A history of high blood sugar thickens connective tissue. Massage helps increase tissue mobility and elasticity, reversing the thickening effect of uncontrolled glucose levels. This tissue inflexibility can manifest as stiffness in muscles, tendons and ligaments, as well as decreased range of motion in the joints. Massage therapy can significantly counter this effect. Additional factors to encourage flexibility and support the myofascial system's health include range of motion techniques, stretching and the inclusion of a regular exercise program.

While massage therapy presents many benefits to people with diabetes, there are some important safety measures requiring a caregiver's attention.

Injection sites
Individuals with Type 1 diabetes typically must self-inject insulin to maintain insulin homeostasis. The increased circulation as a result of massage near the injection area can increase insulin absorption rates. Any increase in the bioavailability of insulin as a result of massage could have drastic consequences for a diabetic so a massage therapist must be sure to avoid the location of any recent injection sites. Prior to working with a diabetic, it is important to ask if and where they inject insulin, to prevent mistakenly working on such an area.

Neuropathy
Neuropathy is a common complication of diabetes, causing dulled or painful sensations on the extremities. As a result, a diabetic may be unable to provide adequate feedback regarding appropriate measures of tactile sensation or heat. Diabetic neuropathy can be extremely painful, requiring a sensitive technique, such as energy work, on affected areas.

Additionally, the chance of bruising, burning or any injury is increased with diabetic clients due to their delicate and easily damageable tissue. Instead of petrissage, deep effleurage or friction, which could potentially further damage delicate skin, the broad, direct pressure of Reflexology or the acupressure techniques of Shiatsu Anma Therapy are safer alternatives. When using any kind of heat therapy on diabetic clients, repeatedly check temperature settings, relying on your own sensitivity to temperature, not the clients', to prevent burning.

Blood Sugar Changes
Primarily to confirm adequately controlled blood sugar, a diabetic must receive physician permission before receiving massage. Even with physician permission, wild fluctuation in blood sugar can occur. Because massage can lower blood sugar, both the client and practitioner must be armed to monitor any sudden changes. Due to the relaxing nature of massage, and the somewhat altered state of consciousness that can occur, a drop in blood sugar can be difficult to notice. Some diabetics can tell when their sugar levels are dropping, while others may not have any awareness. Hypoglycemia (low blood sugar) is a serious condition and can lead to unconsciousness and, rarely, death.

Due to the frequent unpredictability of a diabetic's blood sugar fluctuation, it is important for the massage therapist to recognize the signs and symptoms of hypoglycemia. Any one or more of these symptoms may occur:

· Excessive sweating or clamminess
· Faintness or headache
· Inability to awaken
· Slowed or incoherent speech
· Slowed or delayed movements
· Sudden irritability
· Change in personality
· Rapid heartbeat

If the massage therapist notices any hypoglycemic symptoms, they must ask the client how they feel. A confirmation of a blood sugar reaction or a response that seems "off" requires immediate attention. A blood sugar drop can occur very quickly in diabetes, and is easily addressed with the administration of sugar. Make sure you have sugar available, either in the form of fruit juice, cookies, glucose tablets or some other sweet. Many diabetics carry sugar pills with them for such an event. The diabetic will typically experience an increase in blood sugar within minutes. Be certain that your client is feeling better befoe they get off of the table and again prior to their departure. It may be necessary to eat more sugar or test their blood glucose level to make certain of their safety.

Value Outweighs Risks
Massage can be a wonderful complement to diabetes management. Those affected will appreciate your understanding of their condition, willingness and compassion to avoid exacerbating damaged tissue and preparedness in handling a low blood sugar reaction.

Researching possible diabetes complications and any corresponding massage technique adjustments will further benefit clients suffering from this extremely common metabolic disease. It is critical to maintain open communication with your clients, instituting the exchange of client feedback and the awareness of possible hypoglycemia. Awareness of diabetes's precautions will facilitate the safe enjoyment of massage by your affected clients.

Recommended Study:
Myofascial Release, Reflexology, Shiatsu Anma Therapy

References:
Rose, Mary Kathleen, The Benefits of Massage for People with Diabetes, Massage & Bodywork, Feb/Mar 2001.

Vanderbilt, Shirley, Returning to Native Tradition: An Integrative Approach to Diabetes, Massage and Bodywork, Dec/Jan 2005.

Vest, Gerald W., Acupressure, breath awareness helps diabetes patients, Health and Social Work, New Mexico State University of Social Work, 1997.

www.amtamassage.org, Therapeutic Massage and Diabetes, Mary Kathleen Rose, 2001.

www.dukemednews.com, Stress Management Can Help Control Glucose in Type 2 Diabetes, Duke University Medical Center, 2006.

www.miami.edu, Diabetes, Touch Research Institute, 2006.

by Nicole Cutler, L.Ac.

As summer sends the mercury rising, intolerance to excessive heat grows. When it comes to massage administration, this intolerance poses a contradiction. The nature of bodywork is enhanced with warmth, as higher temperatures encourage tissue relaxation and fluid circulation. However, when a person is overheated, adding even more heat is anything but therapeutic.

At first thought, a cooling technique, such as ice massage, appears to be a logical technique to balance the fiery heat of summer. While valuable for reducing inflammation in acute sports injury work, ice massage will not increase local circulation or relax tense muscles. The solution to providing a balanced therapeutic massage this season is to find ways to support body cooling without sacrificing the aid of warmth in the healing process. Try incorporating some of the following suggestions, or use them to jumpstart your own ideas into your summer client sessions:

1. Cool moonstones - Consider learning how to do a cool moonstone facial. While hot stone massage is a popular choice in colder months, the heat translated by hot stones can be too warming for many individuals already heated by summer’s temperature. The Institute offers the continuing education course, Stone Massage, which includes cool moonstone facial instruction. In addition to the moonstone facial, cool stones can be held in the palm or placed behind the neck to comfortably reduce body temperature.

2. Aloe Vera – A massage medium containing aloe vera creates a cooling sensation, and is particularly effective on sunburned skin. When applied to the lower legs and feet, aloe vera can bring the body’s temperature down a few degrees without inhibiting circulation or relaxation.

3. Room Temperature – The temperature in your massage setting is always a crucial factor, particularly during summertime. Especially if a client is already perspiring and feeling warm, stepping into a hot, stuffy room will only perpetuate their experience of heat. A ceiling fan’s slow setting is an ideal choice to make certain there is air circulation in the treatment space. However, finding the right semblance of cool can be a fine line, as an air conditioner blowing directly on a client can initiate muscular tension and contraction from its chill.

4. Hydrosol Misting – Hydrosols are the pure, water-based solutions created when essential oils are steam distilled. Take advantage of the cooling properties of peppermint or wintergreen to cool and refresh your client. When spraying a hydrosol mist, be aware of and refrain from its use if there are any contraindications present. Additionally, avoid irritation with any essential oil derivative by preventing any eye or mucus membrane contact.

5. Cucumber eye pats – Often used in spa settings, a disc of fresh cucumber placed over the eyes can cool down a flushed face quickly. The cooling and moisturizing properties of cucumber are ideal for a supine client struggling with a hot perspiring body. Always seek permission before placing fresh veggies on your client’s face.

6. Water consumption – Staying hydrated in the heat is crucial, especially when combined with bodywork’s characteristic release of toxins. To reduce overheating, offer your client a bottle of water to sip during, as well as after, your session.

7. Cooling Acupressure – According to Oriental Medical Theory, working the following two locations can reduce internal body heat:

Large Intestine 11 – Located at the lateral end of the transverse cubital crease, midway between the radial side of the biceps brachii tendon and the lateral epicondyle of the humerus. This is a traditional point to reduce fever, revive from heatstroke and reduce all kinds of internal heat conditions.

Governing Vessel 14 – Located just below the spinous process of cervical vertebrae 7. The main point for reducing summer heat, all of the yang (heat containing) meridians intersect here, and is therefore an extremely accessible location to release interior body heat. When this intersection of yang energy is opened, it reduces the accumulation of body heat.

Being aware of your client’s body temperature translates into your awareness of their comfort. The differences in body constitutions will lead some individuals to extreme discomfort in the heat while others will feel their best. When a therapist pays attention to temperature variations and then institutes methods to balance those variations, the client’s experience will be that much more beneficial and therapeutic.

Recommended Study:

Stone Massage

References:

McCampbell, Harvest, Light Summer Massage Lotion Recipe, Massage Magazine, January/February 2001.

www.qi-elements.com, The Five Element Theory, Stefan Karlsson, Dipl. Ac., 2006.

www.tofinotime.com, Summer, Fire, Spirit, Tofinotime Magazine, June 2004.

www.yinyanghouse.com, Acupuncture Points Database, Yin Yang House, 2006.

by Nicole Cutler, L.Ac.

The intimacy of a massage could be the closest physical contact a client has with anyone in their life. All too often, this translates into a client's desire to elongate a session by hanging around to chat post-treatment. After all, the massage therapist may be the only person who listens to them and provides both compassionate and physical interaction.

Assertive communication skills can effectively remove the awkwardness of having a client who simply won't leave. While many massage therapists are compassionate givers with a genuine desire to help people, not all have successfully mastered the art of being assertive.

The three primary styles of communication are aggressive, passive and assertive.

Aggressive
Being aggressive is protecting one's own rights at the expense of the rights of others. Aggressive communicators see their perspective as the only option, and may result to violence or verbal abuse.

Passive
When a person is passive, they allow their own rights to be violated by failing to express their honest feelings. Passive communicators typically defer to others' opinions or desires to avoid conflict.

Assertive
Being assertive is stating and protecting one's feelings, opinions and needs, while still being respectful of others. Assertive communication may feel risky in the moment, but it typically strengthens relationships in the long run.

Many people are concerned that if they assert themselves, others will think of their behavior as aggressive. However, there is a distinct difference between being assertive and aggressive. As opposed to being aggressive, assertiveness does not hurt, abuse or violate the person being addressed.

Assertiveness is an attitude and a way of relating to the outside world, supported by a set of skills for effective communication. To be truly assertive, you need to see yourself as being worthy of respect. At the same time, you value others equally, respecting their right to their opinion as well as to enjoy themselves. Being assertive allows you to engage respectfully with other people, while also valuing your own needs.

An important part of assertiveness is open, secure body language. The way that you present yourself has an impact on how you are perceived and treated by others. Passive body language includes hunched shoulders and avoidance of eye contact, while an aggressive stance is one with clenched fists, glaring eyes and intrusive body language. Assertive people generally stand upright but in a relaxed manner, looking people calmly in the eyes, with hands held open. A good first step to becoming more assertive is to consider your own body language through role play.

According to Dr. Linda Tillman, a licensed clinical psychologist, "Most of our personal styles are established when we are very young. If your parents were rigid and controlling, then you may have felt invalidated so much as a child that now you are afraid to speak up. If you were taught that it is good manners to be focused on the other person and not on yourself, then you may feel that it is not okay for you to ask for what you want."

On a conceptual level, it's easy to understand the need for assertiveness. However, mastering assertive social skills, and being able to use them can be challenging. Being assertive primarily involves three skills:

1. Clearly expressing yourself to others - Leaving any room for doubt or alternate interpretation can open the door to an undesired reaction.

2. Persisting with your goals in the face of opposition - This may require the massage therapist to imitate a broken record, but when done calmly and with logic to support your goal, your intentions are made crystal clear.

3. Appropriately standing up for yourself in the midst of conflict or criticism - Possessing enough self-confidence to demand respect means that you will not tolerate a dismissal of your request.

Many massage therapists encounter the client who refuses to leave. As you depart from the room after completing the massage, state they should take a few moments before getting up and you'll meet them outside at the reception desk in a few minutes. If further suggestions to leave your office are ignored, assertive communication skills can accomplish your needs. Defining your boundaries with yourself and with clients clarifies an appropriate linger time length. Below are some suggestions for being direct, assertively defining your boundaries:

· It was good to see you. I need to prepare for my next client. See you next time.

· I really cannot socialize between sessions because I need to rejuvenate and prepare for my next client. Thank you for respecting this.

· Allow me to escort you out. I value you as a client and appreciate you respecting my schedule.

· (Insert name), our session has come to an end. I hope to see you again soon.

You have the right to set boundaries, even if it feels rude. Being direct is different from being rude. An additional tip towards being direct is to use "I" statements. When using an "I" statement, you own your needs, without passing judgment or attacking someone else.

Learning to become more assertive and clearly define your boundaries takes time and practice. Role play with colleagues or friends, to become comfortable with this newly found strength. Being assertive allows you to communicate better and command respect, ending the frustration of lingering clients, as well as strengthening your confidence as a healing professional.

References:

www.csusm.edu, Assertiveness Training, Cal State San Marcos, 2006.

www.hcd2.bupa.co.uk, Improving Assertiveness, The British United Provident Association Limited, 2006.

www.michigantech.com, Assertiveness Training, Michigan Technological University, 2002.

www.pioneerthinking.com, Speaking Up: How To Be More Assertive, Edel Jarboe, Pioneer Thinking Company, February, 2004.